Provider Demographics
NPI:1164950895
Name:CASTILLO RODRIGUEZ, DANITZA
Entity Type:Individual
Prefix:
First Name:DANITZA
Middle Name:
Last Name:CASTILLO RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 NE 3RD DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7030
Mailing Address - Country:US
Mailing Address - Phone:407-912-6608
Mailing Address - Fax:
Practice Address - Street 1:2630 NE 3RD DR UNIT 102
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7031
Practice Address - Country:US
Practice Address - Phone:407-912-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-61708106S00000X
FL1-20-44635103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician